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Werner's syndrome or progeria, described for the first time in 1886, is a rare disease with autosomal recessive transmission, characterized by premature ageing of connective tissues. About 200 cases have since been reported in the literature. Most patients die young, generally from heart failure due to early coronary atherosclerosis [1]. The authors report the case of a 46-year-old woman presenting with cardiovascular abnormalities, unusual for her age, associated with a particular morphotype belonging to Werner's syndrome.

The authors report the case of a 78 year old woman admitted to hospital for recurrent cerebrovascular accidents, the initial investigation of which was normal. This pacemaker patient had a displacement of the definitive ventricular pacing catheter which was positioned in the left ventricle through a patent foramen ovale. The diagnosis was suspected on clinical and echocardiographic examination and confirmed by transthoracic and transoesophageal echocardiography. In view of the risk of systemic embolism, the pacing catheter was repositioned by an endovascular approach in the right ventricle.

This prospective study in 37 patients evaluated the prevalence of ventricular late potentials in sleep apnea syndrome, a condition associated with an increased risk of ventricular rhythm disorders and sudden death. A comparative analysis was conducted among a group of patients considered free of coronary heart disease and admitted for suspected sleep apnea syndrome based on clinical symptoms and simple blood gas measurements. The prevalence of ventricular late potentials was 56% in the subgroup with and 14% in the subgroup without polygraphy evidence of apnea (F0.01). The analysis of clinical, respiratory, and echocardiographic findings in the apneic subgroup failed to detect any factors associated with the presence of ventricular late potentials. Only long-term follow-up studies involving invasive heart rhythm testing could define the prognostic significance of ventricular late potentials in sleep apnea syndrome. However, our data demonstrate that there is an association between ventricular late potentials and sleep apnea syndrome.

The object of this study was to assess the reliability of measurements of left ventricular volumes and ejection fraction by acoustic quantification by the method of summation of discs in acute myocardial infarction. Thirty-two patients with an average age of 55.9 +/- 12 years were studied prospectively on average 6 +/- 2 days after the onset of myocardial infarction. Within 48 hours, the patients underwent TM echocardiography (Teichholz's method) two-dimensional echocardiography (Simpson's method on freeze frames and acoustic quantification) before left ventricular angiography and isotopic ventriculography, considered as the reference methods for comparing left ventricular volumes and ejection fractions. The data displayed in real time by acoustic quantification correlated well with the results of left ventricular angiography (r = 0.77; p = 0.0001) and moderately underestimated (+4.1 +/- 11.9%) the ejection fraction, but were relatively disappointing for estimating volumes. When compared with isotopic ejection fraction, the correlation coefficient was r = 0.71 (p = 0.0004) and the values were overestimated. In this study, acoustic quantification was the most reliable echocardiographic method of assessing the left ventricular ejection fraction with reference to contrast angiography (Teichholz: r = 0.56; p = 0.0014; Simpson: r = 0.76; p = 0.001). The authors conclude that assessing the left ventricular ejection fraction with acoustic quantification is reliable in acute myocardial infarction. However, the method is not very accurate in measuring end systolic and end diastolic volumes.

The authors report two cases of posterior ventricular septal defects complicating acute myocardial infarction diagnosed by transesophageal echocardiography. Transesophageal echocardiography was well tolerated confirmed the diagnosis, and enabled accurate evaluation of the shunt in the transgastric view. The anatomical results guided the surgical approach and correlated well with the operative findings.

The occurrence of a left ventricular thrombus is a classic complication of acute myocardial infarction. On the contrary, this is much less frequent in the right ventricle. The authors report the case of a patient presenting a biventricular thrombus resulting as a complication of an anterior myocardial infarction, diagnosed by bidimensional ultrasonography. The course is characterized by the occurrence of a cerebral vascular accident. The sonogram following this neurological accident shows that the left ventricular thrombus has disappeared, confirming its migration. On the contrary, the right ventricular thrombus regressed under appropriate heparin treatment, without any embolic complication.

We are reporting the case of a 63 y.old patient whose initial clinical examination and ultrasonographic data had led to the diagnosis of acute aortic dissection. Only an emergency surgical procedure was able to confirm the diagnosis, after failure of angiography and CT-scan to do so. In the light of this example, we are presenting a reminder of the sensitivity of various paraclinical examinations, classically accepted to establish this diagnosis.